Metastasectomy for Oligorecurrent PCa.

[pjoshea13]

New study from Belgium [1].

Small study, but should encourage those with a small number of mets to get treatment.

"Seventeen PCa patients experienced metachronous visceral or skeletal oligometastatic recurrence following maximal local treatment. Oligometastatic recurrence was defined as 1-3 lesions, detected with the best imaging technique available at the time of diagnosis. All patients underwent metastasectomy and were followed for a median of 43 months."

"Fourteen patients (82%) had visceral lesions, two had bone lesions (12%), and one had an abdominal wall metastasis (6%). Four patients (24%) were under active ADT at the time of metastasectomy. PSA decreased after metastasectomy in 16 (94%) patients. Ten (77%) of the 13 ADT-naïve patients had a PSA decrease of ≥ 50%. Following metastasectomy, 16 (94.1%) patients developed metastatic recurrence of which 11 (64.7%) were again oligometastatic, amenable for repeated MDT. The median time to metastatic recurrence was 14 months (range 6.4-40)."

"In this report, we analyzed the outcomes of surgical excision of visceral and skeletal PCa recurrence following primary treatment. We found that removing metastasis to the bone and viscera can be associated with long-term disease-free periods at a low rate of serious complications."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/308...

World J Urol. 2019 Mar 12. doi: 10.1007/s00345-019-02716-8. [Epub ahead of print]

Metastasectomy for visceral and skeletal oligorecurrent prostate cancer.

Battaglia A1, Devos G1, Decaestecker K2, Witters M1, Moris L1, Van den Broeck T1, Berghen C3, Everaerts W1, Albersen M1, Tsaturyan A4, De Meerleer G3, Van Poppel H1, Goffin K5, Ost P6, Tosco L1,5,7, Joniau S8.

Author information

1

Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.

2

Department of Urology, University Hospital Ghent, Ghent, Belgium.

3

Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium.

4

Department of Urology, Astghik Medical Center, Yerevan, Armenia.

5

Nuclear Medicine and Molecular Imaging, KU Leuven, Louvain, Belgium.

6

Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium.

7

Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy.

8

Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. [e-mail].

Abstract

OBJECTIVES:

Metastasis direct therapy (MDT) is a common practice in different fields of oncology. However, there is a lack of data on surgical MDT in visceral/skeletal oligometastatic prostate cancer (PCa). We aimed to assess the role of surgical excision of visceral and skeletal PCa recurrence.

METHODS:

Seventeen PCa patients experienced metachronous visceral or skeletal oligometastatic recurrence following maximal local treatment. Oligometastatic recurrence was defined as 1-3 lesions, detected with the best imaging technique available at the time of diagnosis. All patients underwent metastasectomy and were followed for a median of 43 months. Postoperative complications were graded using the Clavien-Dindo classification of surgical complications. Kaplan-Meier plots were used to assess overall survival.

RESULTS:

Fourteen patients (82%) had visceral lesions, two had bone lesions (12%), and one had an abdominal wall metastasis (6%). Four patients (24%) were under active ADT at the time of metastasectomy. PSA decreased after metastasectomy in 16 (94%) patients. Ten (77%) of the 13 ADT-naïve patients had a PSA decrease of ≥ 50%. Following metastasectomy, 16 (94.1%) patients developed metastatic recurrence of which 11 (64.7%) were again oligometastatic, amenable for repeated MDT. The median time to metastatic recurrence was 14 months (range 6.4-40). We observed 8% Clavien-Dindo grade 3-4 complications in 21 procedures.

CONCLUSIONS:

In this report, we analyzed the outcomes of surgical excision of visceral and skeletal PCa recurrence following primary treatment. We found that removing metastasis to the bone and viscera can be associated with long-term disease-free periods at a low rate of serious complications. These exploratory results should be confirmed in prospective studies.

KEYWORDS:

Metastasectomy; Oligometastatic; Prostate cancer; Radiotherapy; SBRT; Surgery

PMID: 30859274 DOI: 10.1007/s00345-019-02716-8

[NPfisherman]

I believe that MO's are changing their philosophy about dealing with oligometastatic and recurrent disease....there is stereotactic radiation for oligometastatic and recurrent oligoometastatic which are now in trials.....and now this study using surgical metastectomy and showing: "The median time to metastatic recurrence was 14 months (range 6.4-40)."

Buying time as science advances... someone got 40 months... they should see which surgeons are having better results and look at their techniques if this becomes a treatment option..

The science is coming....

Fish

[cesanon in reply to NPfisherman]

????

40 months, or 40 months more compared to what alternative?

????

That is sort of important it would seem?

[NPfisherman in reply to cesanon]

I am guessing what you are implying would be metastectomy vs stereotactic radiation...an interesting area of study... as for metastatic recurrence of 40 months, then someone would have to do some other therapy to get rid of their oligometastatic tumor... tumor free.... and compare I guess they could do that by thermal ablation, alpha tau dart, etc......

I am encouraged by the fact that it seems that the philosophy of treating oligometastatic and oligo recurrent disease is evolving to a hit it hard early and focused on removing tumors/ tumor burden which initially seems to be increasing OS.... They are looking at different options... Now, looking at 10 lesions with SABR-COMET-10...

The tools to treat cancers are changing ...the golden age of medicine is coming.. and I am excited and hopeful...

Fish

[Grumpyswife]

The length of time to radiographic metastatic progression in this study is similar to the length of time my husband was met free after his pCa lesions were surgically removed from his lung.

Of course there would be no identical match for a control/comparison. And the latest scans are much improved from C11 acetate he had. I have always believed it bought him an extra year.